First, laryngoscopy and pharyngoscopy again: The relatively small, exophytic tumor is seen in the area of the left tonsil lobe. Palpation shows clear infiltration into the soft tissues in the upward direction, palatal arch, in the direction of the pharyngeal side wall in depth. There is also extension towards the posterior wall of the hypopharynx. The tumor is now removed transorally on all sides, macroscopically complete, with a safety margin of 1 1/2 cm. Inclusion of the anterior and posterior palatal arch, tonsils including larger parts of the pharyngeal side wall, whereby the external carotid artery is visible with branches in the lower area. Resection caudal to the base of the tongue, towards the center removal of approx. 40% of the posterior hypopharyngeal wall including muscles. The tumor as a whole is thread-marked and a marginal sample of the medial right posterior hypopharyngeal wall is sent in as mucosa and soft tissue. In the frozen section, the edges of the mucosa are healthy on all sides, but there are still tumor extensions cranially, basally and in the direction of the posterior hypopharyngeal wall in the musculature. The decision was therefore made to complete the operation transcervically and cover with a flap. As flap coverage had not been expected, coverage with a platysmal flap was the most suitable solution. The patient is now repositioned for neck dissection on both sides: First start with the right side: incision in front of the sternocleidomastoid muscle in the typical manner. Exposure of the sternocleidomastoid muscle. Dissection of fat lymph node preparation. Exposure of digastric muscle, omohyoid muscle, exposure of cervical vascular sheath, internal and external jugular vein, vagus nerve, accessorius nerve and hypoglossal nerve. Development of the dorsal neck preparation while preserving the branches of the cervical plexus. Subsequent development of the anterior neck preparation, exposing and preserving the superior thyroid artery and the hypoglossal nerve. Overall evacuation level II to IV, followed by layered wound closure with insertion of a Redon drain after careful hemostasis and irrigation. The neck is now dissected on the left and the platysmal flap is elevated: the platysmal flap is marked according to the measured defect size, which is 3 x 6 cm. The platysmal flap is marked with a size of 10 x 6.5 cm, cut around and dissected along the muscle stem in the direction of the submandibular region. Attention is paid to intact venous drainage. The neck is then dissected as on the opposite side, whereby level V is also dissected, so that level II to V are dissected in total. Subsequently, a post-resection is performed under transoral and transcervical control, after exposing the internal carotid artery and looping it, as well as exposing the external carotid artery and its branches, which were located directly within the tumor resection area. The entire prevertebral musculature is removed in the area of the posterior hypopharyngeal wall. A marginal sample of the soft tissue between the mucosa and the prevertebral fascia is also taken. This is marked with a suture. Subsequently, generous resection of the soft tissues of the palatal area cranially, whereby all remaining structures of the pharyngeal side wall are removed. Only the branches of the external carotid artery, the internal carotid artery and the corresponding cranial nerves remain. Generous soft tissue is removed basally cranial to the tube as a marginal sample. There are no more carcinoma infiltrates cranially and in the basal part as well as in the soft tissue area of the posterior wall of the hypopharynx. Therefore, an R0 resection can now be assumed. Removal of the stylohyoid muscles, which was also performed as part of the resection, also created a wide tunnel to the transoral side. The platysmal flap is now pulled through this by its stalk and inserted into the defect. The flap is then sutured in place with 3/0 Vicryl single button sutures. Defect coverage is achieved easily and with little tension. Following extensive skin mobilization, irrigation, hemostasis and layered wound closure on the left side were performed, also using a Redon drain. During the operation, a tracheotomy was also performed in the typical manner. Small Kocher collar incision. Exposure of the infrahyoid musculature and splitting of the same. Exposure of the thyroid isthmus. This is passed underneath, separated and supplied with puncture ligatures. Then enter the trachea in the 2nd/3rd intercartilaginous space and create a small, wide-stemmed Björk flap. Finally, an 8/0 tracheostomy tube is inserted at the end to create a laryngectomy tube. Completion of the procedure without complications. The patient received Unacid 3 g intraoperatively several times as an intravenous antibiotic. Please continue this antibiotic treatment for one week with 3 x 1.5 g i.v. Feeding via the inserted gastric tube for approx. 10 days, then gruel and, if necessary, food build-up. A PEG was not used due to the history of gastric pull-up in esophageal carcinoma. If problems arise with platysmal flap coverage, defect coverage with radial flaps can also be performed in the interval after informing the patient. Due to the deep infiltrative growth, this is a cT2-3 oropharyngeal carcinoma. Because of the cervical lymph node status, radio therapy or even RCT should be discussed postoperatively.